The results of the £39million ProtecT trial by the University of Oxford give confidence to men in choosing active surveillance to monitor early-stage prostate cancer, and highlight the need for better earlier detection.

Men who choose active surveillance have the same survival rate over 10 years as those choosing radiotherapy or surgery, according to new results from a trial that followed 1,500 men diagnosed with localised prostate cancer.

The £39milllion ProtecT trial by the University of Oxford, funded by the National Institute for Health Research, began in June 2001 and randomly allocated men to one of three groups: active surveillance, radiotherapy or surgery. Over the next ten years, only half of the men who were on active surveillance went on to receive either radiotherapy or surgery. Across all groups, 99 per cent of the men survived over ten years regardless of their initial treatment decision.

Good news for men with localised prostate cancer

“These results bring good news for men diagnosed with prostate cancer before it has spread outside the prostate,” says Dr Matthew Hobbs, Deputy Director of Research at Prostate Cancer UK.

“At the moment, many men decide against active surveillance because of the uncertainty about the impact of that choice and the anxiety it causes. It is extremely reassuring to hear that, when it is performed to a high standard, men choosing active surveillance have the same chance of survival at ten years as men who choose surgery or radiotherapy.

“It is important that these results are explained to men with localised prostate cancer, so they can weigh up the positives and negatives of each option, including side effects and risk of cancer progression, and be confident that they have made the best choice for them.”

Active surveillance involves regular monitoring of men with PSA tests and MRI scans to look for signs that the cancer might be progressing before having radiotherapy or surgery. This allows men to avoid or delay experiencing the side effects of these more radical treatments, which include erectile dysfunction, urinary incontinence and bowel problems. In the ProtecT trial this was referred to as active monitoring and did not include MRI scans.

Active surveillance can be offered to men with stage I or II cancer – known as localised cancer, where it has not spread beyond the prostate – who account for just over half of men diagnosed. Many of these cancers may not develop further and spread to other parts of the body and so do not need to be treated. But we currently can’t tell which man’s cancer will progress to this deadly stage, and finding a way to do this is a great challenge for our researchers.

This means that many men receive unnecessary treatment, experiencing the ensuing side effects, for a cancer that may never have affected them. By monitoring the cancer over time and only treating it when there are signs of progression, active surveillance can reduce unnecessary treatment. However, some men, and their doctors, fear that by waiting they might be at greater risk of death.

Huge discrepancy in survival for men diagnosed later

While the results of this trial will help to inform treatment decisions for men with localised cancer, Dr Matthew Hobbs cautioned that “only about half of the 47,000 men diagnosed with prostate cancer each year in the UK are caught at this early stage.

“While they have a 99 per cent chance of surviving for 10 years,” he says, “the latest figures show that only 22 per cent of men diagnosed at the latest stage live this long. This discrepancy demonstrates why we must do all we can to find more cancers at an early stage by raising awareness of the disease and funding research that will deliver better diagnosis.”

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This article was amended to make clear that the trial was funded by the National Institute for Health Research and not Prostate Cancer UK.

Active surveillance

Active surveillance is a way of monitoring slow-growing prostate cancer, rather than treating it straight away. The aim is to avoid unnecessary treatment, or delay treatment and the possible side effects.